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"M-talon uudessa neuromodulaatioyksik\u00f6ss\u00e4 toteutetaan jatkossa psykiatrian omana toimintana navigoivat rTMS hoitosarjat, joiden toteuttamiseen tarvitaan uusi laitteisto. Magneettistimulaatiohoitoja on suunnitelmana toteuttaa viiten\u00e4 p\u00e4iv\u00e4n\u00e4 viikossa virka-ajan puitteissa. (Navigoivan)TMS- j\u00e4rjestelm\u00e4n tulee soveltua sarja-TMS terapioiden antamiseen muun muassa masennuspotilailla, mutta my\u00f6s muilla psykiatrisilla indikaatioilla sek\u00e4 mahdollisesti yhdistettyn\u00e4 kipu- ja tinnituspotilaiden hoitoon. Laitteiston tulee soveltua my\u00f6s Theta-burst hoitojen antamiseen edell\u00e4 mainituissa potilasryhmiss\u00e4. rTMS-hoitojen toteutuksessa teemme tiivist\u00e4 yhteisty\u00f6t\u00e4 Neurofysiologian tutkimusyksik\u00f6n kanssa, joten psykiatrialle hankittavan laitteiston on oltava yhteensopiva neurofysiologian tutkimusyksik\u00f6n laitekannan kanssa. Hoitojen keskitt\u00e4misell\u00e4 psykiatrian yksikk\u00f6\u00f6n pyrit\u00e4\u00e4n lis\u00e4\u00e4m\u00e4\u00e4n psykiatristen rTMS hoitojen resursseja, jolloin rTMS hoitoja olisi tulevaisuudessa tarjolla useammille potilaille.",
"",
"Laitteiston tulee olla yhteensopiva Sein\u00e4joen keskussairaalan KNF yksik\u00f6ss\u00e4 k\u00e4yt\u00f6ss\u00e4 olevan Bittium Biosignals Oy:n toimittaman (Magstim Rapid + Visor 2 navigointi) magneettistimulaatiolaitteiston kanssa, mik\u00e4 edellytt\u00e4\u00e4 yhtenev\u00e4\u00e4 eli k\u00e4yt\u00e4nn\u00f6ss\u00e4 saman valmistajan laitteistoa kuin KNF -yksik\u00f6ss\u00e4. Perusteet laitteiston yhtenevyysvaatimukselle ovat toiminnalliset. Ensimm\u00e4isell\u00e4 hoitokerralla m\u00e4\u00e4ritet\u00e4\u00e4n motorinen kynnys (MT, motor threshold) navigaatioon kuuluvaa 2-kanavaista EMG:t\u00e4 hy\u00f6dynt\u00e4en, se mittaa stimulaation aiheuttamat motoriset vasteet ja tallentaa vastaavan kelan paikan ja suuntauksen. Suurimman vasteen antavasta paikasta mitataan pienin stimulaatiointensiteetti, jolla vastetta viel\u00e4 saadaan esille. T\u00e4m\u00e4 motorinen kynnys on hoidon intensiteetin m\u00e4\u00e4r\u00e4\u00e4v\u00e4 parametri. 3d -mallit ja hoitokohteiden merkkaukset pit\u00e4\u00e4 voida tehd\u00e4 sek\u00e4 nykyisin KNF:ll\u00e4 olevalla laitteistolla ett\u00e4 hankittavalla laitteistolla ja oltava siirrett\u00e4viss\u00e4 suoraan laitteistojen v\u00e4lill\u00e4 ilman erillisi\u00e4 lis\u00e4toimenpiteit\u00e4. Samoin motorinen kynnys tulee voida m\u00e4\u00e4ritell\u00e4 sek\u00e4 nykyisin KNF:ll\u00e4 olevalla laitteistolla ett\u00e4 hankittavalla laitteistolla ja motorisen kynnyksen arvot on oltava siirrett\u00e4viss\u00e4 suoraan laitteistojen v\u00e4lill\u00e4 ilman erillisi\u00e4 lis\u00e4toimenpiteit\u00e4. ",
"",
"Jatkossakin potilaiden ensik\u00e4yntej\u00e4 eli ns m\u00e4\u00e4ritysk\u00e4yntej\u00e4 ja niihin liittyvi\u00e4 esivalmistelutoimenpiteit\u00e4 toteutetaan KNF -yksik\u00f6st\u00e4, mink\u00e4 j\u00e4lkeen potilaan hoitosarja toteutetaan neuromodulaatiopoliklinikalla. Tarvittaessa KNF -yksik\u00f6n toimintaan voidaan my\u00f6s hy\u00f6dynt\u00e4\u00e4 psykiatrian poliklinikan laitteistoa. T\u00e4m\u00e4 takaa kustannustehokkaan kokonaistoiminnan. rTMS \u2013hoidossa potilas k\u00e4y ensin magneettikuvassa, mink\u00e4 j\u00e4lkeen kuvan perusteella potilaan p\u00e4\u00e4st\u00e4 tehd\u00e4\u00e4n kolmiulotteinen malli ja merkit\u00e4\u00e4n malliin hoitokohteet. N\u00e4m\u00e4 valmistelevat toimenpiteet suoritetaan rTMS \u2013navigointiohjelmistossa. Tehdyt mallit siirret\u00e4\u00e4n edelleen hoitokoneelle ja ensimm\u00e4iselle kartoituskerralla potilaalle m\u00e4\u00e4ritell\u00e4\u00e4n lepomotorinen kynnys, johon varsinainen hoitotaso suhteutetaan, sek\u00e4 tulevat hoitokohteet. Potilaiden hoitamiseksi tarvittavan tiedon ja potilaskohtaisten m\u00e4\u00e4ritysten siirt\u00e4minen yksik\u00f6iden ja laitteiden v\u00e4lill\u00e4 (KNF-neuromodulaatiopkl) edellytt\u00e4\u00e4 laitteistojen yhtenevyytt\u00e4 (eli k\u00e4yt\u00e4nn\u00f6ss\u00e4 saman laitekannan k\u00e4ytt\u00e4mist\u00e4). Sama laitekanta on edellytys sille, ett\u00e4 valmistelevia toimenpiteit\u00e4 voidaan tehd\u00e4 KNF:ll\u00e4 ja edelleen potilaita siirt\u00e4\u00e4 hoitoon psykiatrian neuromodulaatiopoliklinikalle (tai toisinp\u00e4in). Yhtenev\u00e4isist\u00e4 laitteistoista saadaan merkitt\u00e4vi\u00e4 synergiahy\u00f6tyj\u00e4 toiminnan optimoimiseen ja kustannustehokkaaseen toteuttamiseen kahden yksik\u00f6n v\u00e4lill\u00e4, mik\u00e4 ei ole mitenk\u00e4\u00e4n mahdollista eri laitekannoilla. Yhten\u00e4inen laitekanta my\u00f6s lis\u00e4\u00e4 huoltovarmuutta mahdollisen laiterikon sattuessa kun potilaiden hoito on siirrett\u00e4viss\u00e4 yksik\u00f6iden v\u00e4lill\u00e4. Eri valmistajien laitteistot eiv\u00e4t ole kesken\u00e4\u00e4n yhteensopivia ja n\u00e4in ollen kaikki synergiahy\u00f6dyt menetet\u00e4\u00e4n kokonaisuudessaan, mik\u00e4li p\u00e4\u00e4dyt\u00e4n eri laitekantoihin. Potilaiden hoidot ja esivalmistelut eiv\u00e4t ole siirrett\u00e4viss\u00e4 yksik\u00f6st\u00e4 toiseen mik\u00e4li yksik\u00f6iss\u00e4 on eri laitekanta, mik\u00e4 heikent\u00e4\u00e4 merkitt\u00e4v\u00e4sti toiminnan kustannustehokkuutta ja resurssien optimointia. Yhtenev\u00e4inen laitekanta mahdollistaa saumattomat palveluketjut potilaille."
]
}
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"dateCreated": "2021-04-12T10:52:24.3616597",
"dateModified": "2021-04-12T11:07:38.6405072"
}